Torn ACL

[dk_b]

This thread has been quiet for a while…wondering how people are doing. My son is almost 6 months postop and continues to work on strengthening and PT everyday. Like many said it has gone by pretty fast. Other than not playing soccer his life is pretty busy and normal. This last stretch before return to play is going to be challenging! It’s hard to know how cautious to be with him nowadays since he feels so good! Hope everyone else’s kid is doing well. I’m curious how long it took your son or daughter to get back into the groove after returning to play?

My twins returned to the pitch in spring and you could see some moments in those spring games. They did not play a ton in summer but they looked fully themselves in the fall club season and first half of HS. Then, and you are not going to believe this, in a span of 2.5 wks BOTH tore their OTHER ACLs (one will be 3 wks post surgery on Mon, the other one week on Tues). The good news: their surgically repaired right knees have been holding up just fine. (And, yes, they are identical)

 

[anita]

Wow that is unbelievably hard! I can only imagine what an ordeal this has been for you and your daughters. I guess the good news is the surgical knee has stayed strong. I hope they can once again recover fully. Did you guys do extensive return to sport testing? Our PT suggested we go to a special place in LA that only does return to play evaluations at the 9-10 month mark and only then make the decision to return. I feel like every time a kid gets re-injured they have been cleared by professionals and yet it still happens! How frustrating!

 

[crush]

My twins returned to the pitch in spring and you could see some moments in those spring games. They did not play a ton in summer but they looked fully themselves in the fall club season and first half of HS. Then, and you are not going to believe this, in a span of 2.5 wks BOTH tore their OTHER ACLs (one will be 3 wks post surgery on Mon, the other one week on Tues). The good news: their surgically repaired right knees have been holding up just fine. (And, yes, they are identical)

Sending the twins positive thoughts and a healthy recovery. I know a player that has had both acl's torn but are now saying the knees are better then the old ones

 

[Surf Zombie]

This thread has been quiet for a while…wondering how people are doing. My son is almost 6 months postop and continues to work on strengthening and PT everyday. Like many said it has gone by pretty fast. Other than not playing soccer his life is pretty busy and normal. This last stretch before return to play is going to be challenging! It’s hard to know how cautious to be with him nowadays since he feels so good! Hope everyone else’s kid is doing well. I’m curious how long it took your son or daughter to get back into the groove after returning to play?

My DD was at 9 months post surgery early September, which was also the start of her HS season. We limited her to 5-10 minutes for the first few weeks so she could get use to contact again. That built up to 10-15 minutes per half by the end of the HS season in mid-November.

The HS seasoned ended and she played about a dozen ECNL league and showcase games between Thanksgiving and mid January. She was playing 20 per half at that point. She has a showcase this coming weekend (15 months post surgery) and it will be her first games with no minute restrictions. She is playing with her brace on and continuing with her post surgery strengthening routine. So far so good.

Watching her, I feel like her ball skills looked like she hadn't missed a beat, but her game fitness and confidence had to be built back slowly. Long road for sure. We took a cautious return to play approach, as she is only a sophomore, so playing the long game. Good luck to you son!

 

[Surf Zombie]

My twins returned to the pitch in spring and you could see some moments in those spring games. They did not play a ton in summer but they looked fully themselves in the fall club season and first half of HS. Then, and you are not going to believe this, in a span of 2.5 wks BOTH tore their OTHER ACLs (one will be 3 wks post surgery on Mon, the other one week on Tues). The good news: their surgically repaired right knees have been holding up just fine. (And, yes, they are identical)

So sorry to hear this.

 

[NorCalUSN]

My twins returned to the pitch in spring and you could see some moments in those spring games. They did not play a ton in summer but they looked fully themselves in the fall club season and first half of HS. Then, and you are not going to believe this, in a span of 2.5 wks BOTH tore their OTHER ACLs (one will be 3 wks post surgery on Mon, the other one week on Tues). The good news: their surgically repaired right knees have been holding up just fine. (And, yes, they are identical)

It hurts my heart to see this. Everytime I think about my daughter on the pitch again I worry about reinjury the surgery, and post surgery journey to replay. I'm so sorry for what your twins have suffered. I wish you and your family luck.

 

[dk_b]

It hurts my heart to see this. Everytime I think about my daughter on the pitch again I worry about reinjury the surgery, and post surgery journey to replay. I'm so sorry for what your twins have suffered. I wish you and your family luck.

Thank you (and to @Surf Zombie @crush and @anita). They are amazingly resilient and I think the fact that their right knees (repaired in April and June 2021, respectively) have been good is something that is heartening to them. Further, they are so much stronger physically than at this point the first time. And the learning curve of rehab - such as when learning a specific exercise might take 20 mins the first time, it might take only 5 as a refresher this time - bodes well for them. And, Anita, part of their "clear to play" is to do a motion/strength analysis that is quite detailed (both failed the first assessment in 2021 but now that they know, they will have a better chance of passing (they were fine on the motion, it was the strength - in particular, the quad:hamstring strength ratio assessment) - that delayed their return).

What was tough was sectional playoffs this past week - one was able to attend the first game but neither went to the 2d game (first was home but second was a decent drive from our house and that was just too much for the one that was a couple of weeks post-surgery). They watched their big sister play when she was in HS and, in her Sr year, lead her team to the sectional final (something that had never happened in program history) and really wanted to help make a run. The team showed a lot of heart in losing 2-1 to a sectional power but I am not sure they could even watch the live stream.

I don't think theirs is a cautionary tale but more of a combination of the reality of the risk associated with girls' soccer combined with an absolute fluke. I trust the rehab process for getting them back and then just hope they have the psychological reserves to get them to where they were in, say, October (full confidence, full skill) a bit faster this go around. (when they missed their club season in fall 2021, we were able to get to most of my older daughter's college games so we will try to make the most of this coming fall and maybe couple that w/college visits (looking at small schools w/D3 programs that, perhaps, will take a flyer on them, though we have a longer trip with their big sis having transferred across the country so not sure how often they can join us))

 

[socalkdg]

I pray of no injuries for all the kids out there. Sadly it still happens. Big props to all the kids that get hurt and work their way back.

I've heard people talk about the importance of wearing turf cleats when playing on turf. Is this something kids are doing? Are they getting hurt on turf or grass?

 

[dk_b]

I pray of no injuries for all the kids out there. Sadly it still happens. Big props to all the kids that get hurt and work their way back.

I've heard people talk about the importance of wearing turf cleats when playing on turf. Is this something kids are doing? Are they getting hurt on turf or grass?

of our now 4 tears, 3 occurred on turf and 1 on grass. There are so many variables and addressing any one is part of the process of risk mitigation (can never have risk elimination, of course). Their Dr has a preference for turf cleats but only “mandates” it during some of the earlier phases before full RTP. I do think they will use them this next time they are cleared but it’s really hard to pin it on that. I think overuse is a bigger risk at large (even if any one player who was injured was fit and not seemingly tired).

It’s all a balance of variables. Control the controllables as much as possible and mitigate the risk to the extent possible.

 

[Colorado Papa]

My twins returned to the pitch in spring and you could see some moments in those spring games. They did not play a ton in summer but they looked fully themselves in the fall club season and first half of HS. Then, and you are not going to believe this, in a span of 2.5 wks BOTH tore their OTHER ACLs (one will be 3 wks post surgery on Mon, the other one week on Tues). The good news: their surgically repaired right knees have been holding up just fine. (And, yes, they are identical)

So sorry to hear this dk_b. What an emotional rollercoaster this must be for you all. My daughter just tore her ACL in her first semester at college and I just spent the last couple of days making it through this thread. Thank you for sharing your experience and prayers to your family.

 

[dk_b]

So sorry to hear this dk_b. What an emotional rollercoaster this must be for you all. My daughter just tore her ACL in her first semester at college and I just spent the last couple of days making it through this thread. Thank you for sharing your experience and prayers to your family.

thank you, @Colorado Papa

 

[anita]

So sorry to hear this dk_b. What an emotional rollercoaster this must be for you all. My daughter just tore her ACL in her first semester at college and I just spent the last couple of days making it through this thread. Thank you for sharing your experience and prayers to your family.

Sorry to hear that your daughter has to go through this. It is incredibly hard when the diagnosis first becomes clear but as many people on this thread can attest to getting started on rehab and then recovery after surgery helps the time pass. The first few days after surgery my son swore he would never play again because he didn’t want to go through this experience again….now 6 months later he is stronger and more motivated than ever. He will never take being healthy and fit for granted again ! When he does return to playing ina. Few months i know he will have done everything possible to prevent another tear but luck (bad luck) is also part of the equation and we will deal with whatever happens. Good luck as you embark on this journey.

 

[Surf Zombie]

There is no magic bullet, but my biggest takeaway for prevention is an appropriate strength ratio between the girl’s hamstrings and quads. Soccer players tend to have strong quads and weak hamstrings, which stresses the ACL. Build up the hamstring strength, be as flexible as possible, wear the appropriate cleats for the playing surface. Again, not guarantees, but those steps will minimize risks.

 

[dk_b]

So sorry to hear this dk_b. What an emotional rollercoaster this must be for you all. My daughter just tore her ACL in her first semester at college and I just spent the last couple of days making it through this thread. Thank you for sharing your experience and prayers to your family.

thank you, @Colorado Papa

There is no magic bullet, but my biggest takeaway for prevention is an appropriate strength ratio between the girl’s hamstrings and quads. Soccer players tend to have strong quads and weak hamstrings, which stresses the ACL. Build up the hamstring strength, be as flexible as possible, wear the appropriate cleats for the playing surface. Again, not guarantees, but those steps will minimize risks.

Exactly right. Risk mitigation and probably the single variable most in the player's control is balancing out the quad:hammy strength. 2d most - but still hard - is to try to avoid playing back-to-back games (esp if you are a full 90 min player). No matter how fit a player is, by min 120 or 150, her muscles are going to be tired. It's a reason why we don't see back-to-back games in college or in pro/international tournaments. That said, the social pressure to play is very, very high. And, if they are in a highly-scouted event (say, an ECNL showcase), nobody is going to want to miss being seen. I do wish that CIF would impose a state-wide rule of no back-to-backs after, say, Jan 1 (when the full load is building up). I don't think that is going to happen but that will be part of my girls' protocol next year (one twin was injured in the 3d game in 4 days - Wed, Fri, Sat (Sat was non-league and that's when it happened). She was super fit and playing well and strong but, as we are saying, control the controllables and mitigate the risk.

 

[Colorado Papa]

Curious if anyone’s player has gotten a quad graft with internal brace. The strength of the tendon along with having a seat belt, so to say, is very appealing. Ortho’s doing this seem to be sparse throughout the country….any experience out there?

 

[crush]

And, if they are in a highly-scouted event (say, an ECNL showcase), nobody is going to want to miss being seen. I do wish that CIF would impose a state-wide rule of no back-to-backs after, say, Jan 1 (when the full load is building up). I don't think that is going to happen but that will be part of my girls' protocol next year (one twin was injured in the 3d game in 4 days - Wed, Fri, Sat (Sat was non-league and that's when it happened). She was super fit and playing well and strong but, as we are saying, control the controllables and mitigate the risk.

100%. I had to step in during my dd 11th and 12th grade and say, "no mas" and took heat for it. Back(Fri) to back(Sat) to back(Sun) was the pressure if you want to show these top coaches how amazing you are. The pressure is insane. I tore my left ACL when I was 27 playing basketball. It sucks but with todays technology, you can get a stronger ACL and be stronger player. Just say no if they try and make your kid feel guilty or use fear tactics if they only one to play one game on the weekend. Who makes all the money at the showcases? Who are the one's doing most of the working and not getting paid? One game a week is plenty and maybe a friendly during the week. I just heard from a good pal and his dd tore her acl so this is happening way too much. I wish everyone's dd & ds a speedy recovery.

 

[Red card]

This thread has been quiet for a while…wondering how people are doing. My son is almost 6 months postop and continues to work on strengthening and PT everyday. Like many said it has gone by pretty fast. Other than not playing soccer his life is pretty busy and normal. This last stretch before return to play is going to be challenging! It’s hard to know how cautious to be with him nowadays since he feels so good! Hope everyone else’s kid is doing well. I’m curious how long it took your son or daughter to get back into the groove after returning to play?

My daughter recovered from her ACL and started playing....7 games in right before Surf cup the other ACL tore. Still only 3 1/2 months post op. Both happened right before major show cases and the coaches (a couple) were coming to see her. Heart breaking but one school is willing to take a chance on her. No money but training and a chance to make the team when she's ready. Hopefully she stays healthy. good luck to all the folks on this forum's player.

 

[dk_b]

Curious if anyone’s player has gotten a quad graft with internal brace. The strength of the tendon along with having a seat belt, so to say, is very appealing. Ortho’s doing this seem to be sparse throughout the country….any experience out there?

Thing 2 (she was 2d born of my twins and her tears were #2 and #4 of the 4 injuries the two have had) had quad tendon for her right ACL tear (in 2021). I don't recall whether it was with an "internal brace". I will check her chart if I can and message you if I have any insight.

And, Papa, it was lame of me to only say "thank you" w/o commenting about your daughter. Prior to joining this club, I'd have felt bad for her and for you. But the transition from having gone through it, "feeling bad" is now "feeling ill". I'm so sorry.

My daughter recovered from her ACL and started playing....7 games in right before Surf cup the other ACL tore. Still only 3 1/2 months post op. Both happened right before major show cases and the coaches (a couple) were coming to see her. Heart breaking but one school is willing to take a chance on her. No money but training and a chance to make the team when she's ready. Hopefully she stays healthy. good luck to all the folks on this forum's player.

Damn, Red Card. As a parent, you know exactly what we are going through. And, as kids, your daughter knows what my girls are going through. Your girl is going to make coach happy to have shown patience. I can feel it!

 

[supercell]

There is no magic bullet, but my biggest takeaway for prevention is an appropriate strength ratio between the girl’s hamstrings and quads. Soccer players tend to have strong quads and weak hamstrings, which stresses the ACL. Build up the hamstring strength, be as flexible as possible, wear the appropriate cleats for the playing surface. Again, not guarantees, but those steps will minimize risks.

As an aside, it has always been curious to me that so many surgeons recommend the hamstring graft for young females. At least initially, this technique makes the quad/hamstring imbalance problem worse. The gold standard BTB graft does not have this drawback, but has other issues. It seems like if this imbalance were a driving factor, nobody would use the hamstring graft. Unfortunately there are so many factors involved in contralateral tears that I doubt the statistics on injury rate vs graft type allow many conclusions to be drawn.

For those that have current ACL injuries, was the BEAR implant considered?

 

[dk_b]

As an aside, it has always been curious to me that so many surgeons recommend the hamstring graft for young females. At least initially, this technique makes the quad/hamstring imbalance problem worse. The gold standard BTB graft does not have this drawback, but has other issues. It seems like if this imbalance were a driving factor, nobody would use the hamstring graft. Unfortunately there are so many factors involved in contralateral tears that I doubt the statistics on injury rate vs graft type allow many conclusions to be drawn.

For those that have current ACL injuries, was the BEAR implant considered?

We did not discuss the BEAR implant. I have a close relationship with our surgeon so I will ask him.

My girls did the following: Thing 1 - patellar for right, patellar for left; Thing 2 - quad for right, patellar for left. Despite being identical, Thing 2's growth plates were a bit more open (long story as to likely why and not relevant here) and he felt that quad made more sense. This time, they are physiologically identical and their procedures are.

My understanding is that this surgeon does NOT do hamstring grafts for young athletes (perhaps non-athletes) and that the failure is higher and the impact on the athlete is greater. I have a family member who tore her ACL twice and the 2d time had to use hamstring (rather than cadaver (the highest failure rate among young athletes) or quad) b/c of the prior surgery (not the same surgeon for the 2d one for this person).

In looking at the BEAR implant just now, I am confident that while this injury will not go away, treatment will be very different in 5 or 10 years than it is today (just like it is so different compared to what it was when we were kids)